December 2013

A possible dental public health crisis is looming in Israel. How can this be? As many as 70% of the Israeli population are currently supplied with optimally fluoridated water and oral health studies carried out in Israel over the past decade have demonstrated the benefits. For example, a national study of Israeli 12-year olds in 2002 (Zusman et al., 2005) found an average DMFT of 1.39 in fluoridated areas compared with 1.83 in non-fluoridated ones. The national mean DMFT, in this study, was 1.66. Ten years later, in 2011/12, a study (yet unpublished) of 12-year olds by Jerusalem’s Hebrew University-Hadassah Dental School (commissioned and financed by the Israeli Ministry of Health) reported an average national DMFT of 1.17. This decline was predominantly attributed to water fluoridation and the use of fluoride dentifrices. The recent study found a DMFT level of 0.98 among 12-year olds residing in fluoridated cities compared with 1.38 among those residing in non-fluoridated cities (statistically significant). It also showed a marked effect of fluoridation on the inequalities caused by socio-economic position (SEP). Among children residing in non-fluoridated areas, a level of 1.52 DMFT was found among low SEP groups, compared with 1.20 DMFT in higher SEP groups. This gap was almost eliminated in fluoridated areas: 1.01 DMFT among low SEP groups, compared with 0.97 among higher SEP groups. Additionally, the study revealed (in a multiple logistic regression model that considered ethnic group, health behaviour, SEP and other independent variables) that children residing in fluoridated areas had twice the chance of being caries-free than children in non-fluoridated areas (OR=2.11). In comparison with other countries, the study found low levels of dental fluorosis. Yet, despite these fluoridation success stories, this important public health measure could be under threat following the decision of a new Health Minister not to renew regulations that require the national water company, Mekorot, to fluoridate water supplied to all Israeli communities with more than 5,000 people. Some internet-based reports claiming that Israel’s Supreme Court has banned fluoridation are wrong (Jerusalem Post, 2013a). The Court found no basis for doing so – whether in relation to anti-fluoridation allegations about efficacy or adverse effects. The decision not to renew the regulations was political, not judicial, and was taken by the Minister, not the Court.